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Home My WebLink About4-17-13U. alyI>f SIERASTIAN ,.S4uuro�+ HOME Of PELICAN ISLAND Certificate No. 2017 CITY OF 5EBA T'u_ `_ Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: W. Osborne Evans /Flossie F. Evans/ William O. Evans (name) 8241 NW 1760 Tern, Hialeah, Fl 33015 (address) in and for consideration of the sum of $950.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit —4— Block 17 Lots 13 of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 11th day of May, 2005. CITY OF SEBASTIAN, FLORIDA ATTEST: J James A. Davis Sall A. Maio, MMC tenm City Manager City Clerk 0��' O, O Name Unit Block Lot Date of Mark-out Time Date of Burial Name of Funeral Home Authorized by ,�; • ,c, Total Paid �O�0 Initials White - Dept. of Origin a Yellow - Finance • Pink • Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 3 °J Q G Name ❑ Cash Date d4reck // 7X # No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDC /Code of Ordinances 001501341930 Election Qualifying Fees 601010'343800 Cemetery Lots D. v Lot/NIche 1_ Block Unit 001501343805 Cemetery Fe r ,�; • ,c, Total Paid �O�0 Initials White - Dept. of Origin a Yellow - Finance • Pink • Applicant FLORIDA DEPARTMENT jk) HEALT A. (TYPE) 1. Name of Deceased First Flossie State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT Middle Last Date Month Day Year of Forest Evans Death May 06 2005 2. Place of Death - City, Town or Location Name of (If neither, give street address) County Hosp. or Broward Ft. Lauderdale Inst. Florida Medical Center 3. Name of Medical Address Phone Number Certifier Tammiraju Kalidindi 0 N.W. 5th Street. Suite 103, Fort Lauderdale, Florida 333 Medical Examiner Physician 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 1655 27th Street Thomas S. Lowther Funeral Home Vero Beach, Florida 32960 2559 (772) 778 -3233 5. Check a. The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. Dr. Kalidindi was contacted on 5/6/2005 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that He will complete and sign the medical certification of cause of death within 72 hours. C. was contacted on He /she verified that Medical Examiner, will complete and sign the medical certification of cause death within 72 hours. 6. Funeral Director/ Sig tore F.E. No. /Reg. No. Date Signed Direct Disposer L 2588 May 6, 2005 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 2559-05-114 EkA five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause -of -death section of the death certificate within 72 hours. nNo extension of time for filing the death ertificate has bee Registrar or 1 6 Date Date Certificate Subregistrar Signatur Issued: May 6, 2005 Dye: May 20, 2005 C. AUTHOKIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Approval Number: Date Medical Examiner, gave authorization by telephone to Funeral Director /Direct Disposer. Date The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48 hours after death is required for all cremations. D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemetery BURIAL OCREMATION Signature of Sexton or Person -in- Charge ®STORAGE ❑OTHER (Specify) Date of Disposition May 10, 2005 This permit must be endorsed by the Sexton or person -in- charge (or by the Funeral Director /Direct Disposer when there is no Sexton) and returned within 10 days to the local County Health Department in the county where disposition occurred. DH 326, 6/97 (Obsoletes all previous editions) (Stock Number: 5740 - 000 -0326 -2) Distribution: White: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Local Registrar e.-,d d %I P-p- aff (A SEIDASTKN'' HOME OF PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase 61 X' Name(s) 16A41 " Address Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: D o� 727—' ,L1_ ..2 Dollars ($ 9-f— o. Q d ) on this // day of _,emu , 200_�for the purchase of the following described Cemetery Lot(s) and7or Niche(s). Unit , Block /% , Lot(s) /LF Niche(s) for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. Additional Fees paid at time of purchase: Corner Markers (set of 4 - $20) Opening &Closing o d l _Y W. ) O H Circle One Vase and Ring for Niches (cost) Interment.,,— Disinterment Signature of Purchaser of Sebastian OT Service fees are to be paid at time of need only I: \W W- DATA \Ms - Cemetery\RECEI PT.doc WE Flossie Evans, Hialeah Flossie F. Evans, 85, died May 6, 2005, at the Florida Medical Center, Fort Lauder- dale. She was born in Messick, Va., and lived in Sebastian for 25 years, coming from Hi- aleah. She was a member of the Fellsmere Community Bible Church of Fellsmere and the Bible Baptist Church of Pem- broke Pines. She was the Fellsmere church book- keeper for 15 years and was active•in the church choir. She was an avid reader. Survivors include her hus- band of 64 years, W. Osborne "Ozzie" Evans of Hialeah; sons, William O. "Ozzie" Evans Jr. of Hialeah, Floyd F: Evans of San Jose, Costa Rica, and David N. Evans of North Carolina; daughter, Theresa Dale of Chicago; seven grandchildren; and four great- grandchildren. `Memorial contributions may be made to the Fells- mere Community Bible Church Mission Fund, 14 N. Hickory St., Fellsmere, FL 32948. SERVICES: Visitation will be from noon until 2 p.m. May 10 at the Fellsmere Community Bible Church, with a service at 2 p.m. with. the Rev. Leon Essex officiat- ing. Burial will follow in Se- bastian Cemetery, Sebastian. Arrangements are by the Thomas S. Lowther Funeral Home & Crematory, Vero Beach. ,1S 15EAAST'' HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, Fl 32958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 May 11, 2005 W. Osborne Evans /William O. Evans 8241 NW 170`h Terrace Hialeah, F133015 Dear Mr. Evans: Enclosed is City of Sebastian Certificate 2017 for the purchase of Cemetery Lot 13, Block 17, Unit 4. Also enclosed is a copy of your receipt and the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. . Sinc ly, Sally A. M o, MMC City Clerk SAM:ar enclosure